MEDICARE: JUSTIN KAISER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	37656	SC

General Provider Information

NPI Number	:	1235615469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN KAISER PHARMD

Provider Business Mailing Address
First Line	:	125 MARYPORT DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29575-6513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 MARYPORT DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29575-6513
Country	:	US
Telephone Number	:	843-232-0495
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2018
Last Update Date	:	07/11/2018

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